Liver and Spleen Stiffness Measurement

  • Yoshihiro FuruichiEmail author
  • Fuminori Moriyasu


Esophageal varices (EV) are often complicated in cirrhotic patients, and bleeding from EV induces high mortality rate. Endoscopic screening for EV and hepatic venous pressure gradient (HVPG) is recommended for all cirrhotic patients; however, these are invasive procedures. Liver stiffness (LS) measurement (LSM) is a noninvasive technique using elastographic method by ultrasonography or magnetic resonance imaging and is a very useful examination method to assess significant fibrosis and to rule out liver cirrhosis (LC). LS values are thought to increase gradually alongside the increment of HVPG in line with the progresses of LC state. However, regarding the presence of EV, spleen stiffness (SS) is a more accurate predictor with high area under receiver operating characteristic curve than LS. The measurement of SS values can reveal cirrhotic patients with high-risk EV. Moreover, measuring the spleen/liver stiffness ratio by elastography made it possible to noninvasively, specifically, and accurately diagnose idiopathic portal hypertension or extrahepatic portal vein obstruction.


Liver stiffness Spleen stiffness Esophageal varices Portal hypertension Ultrasonography Elastography Idiopathic portal hypertension Extrahepatic portal vein obstruction 


  1. 1.
    Bosch J, Garcia-Pagán JC, Berzigotti A, Abraldes JG. Measurement of portal pressure and its role in the management of chronic liver disease. Semin Liver Dis. 2006;26:348–62.CrossRefGoogle Scholar
  2. 2.
    Burroughs AK, Groszmann R, Bosch J, Grace N, Garcia-Tsao G, Patch D, et al. Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure gradient a better end point? Gut. 2002;50:425–7.CrossRefGoogle Scholar
  3. 3.
    Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–38.CrossRefGoogle Scholar
  4. 4.
    de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;53:762–8.CrossRefGoogle Scholar
  5. 5.
    Targownik LE, Spiegel BM, Dulai GS, Karsan HA, Gralnek IM. The cost-effectiveness of hepatic venous pressure gradient monitoring in the prevention of recurrent variceal hemorrhage. Am J Gastroenterol. 2004;99:1306–15.CrossRefGoogle Scholar
  6. 6.
    Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.CrossRefGoogle Scholar
  7. 7.
    Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.CrossRefGoogle Scholar
  8. 8.
    Lupsor Platon M, Stefanescu H, Feier D, Maniu A, Badea R. Performance of unidimensional transient elastography in staging chronic hepatitis C. Results from a cohort of 1,202 biopsied patients from one single center. J Gastrointestin Liver Dis. 2013;22:157–66.PubMedGoogle Scholar
  9. 9.
    Vergniol J, Foucher J, Terrebonne E, Bernard PH, le Bail B, Merrouche W, et al. Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C. Gastroenterology. 2011;140:1970–79, 1979.e1–3.CrossRefGoogle Scholar
  10. 10.
    Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, Petrarca A, Moscarella S, Belli G, Zignego AL, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007;45:1290–7.CrossRefGoogle Scholar
  11. 11.
    Ichida F, Tsuji T, Omata M, Ichida T, Inoue K, et al. New Inuyama Classification for histological assessment of chronic hepatitis. Hepatol Commun. 1996;6:112–9.CrossRefGoogle Scholar
  12. 12.
    Reiberger T, Ferlitsch A, Payer BA, Pinter M, Homoncik M, Peck-Radosavljevic M. Non-selective β-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis. J Gastroenterol. 2012;47:561–8.CrossRefGoogle Scholar
  13. 13.
    Masuzaki R, Tateishi R, Yoshida H, Goto E, Sato T, Ohki T, et al. Prospective risk assessment for hepatocellular carcinoma development in patients with chronic hepatitis C by transient elastography. Hepatology. 2009;49:1954–61.CrossRefGoogle Scholar
  14. 14.
    Robic MA, Procopet B, Métivier S, Péron JM, Selves J, Vinel JP, et al. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. J Hepatol. 2011;55:1017–24.CrossRefGoogle Scholar
  15. 15.
    Shi KQ, Fan YC, Pan ZZ, Lin XF, Liu WY, Chen YP, et al. Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int. 2013;33:62–71.CrossRefGoogle Scholar
  16. 16.
    Kazemi F, Kettaneh A, N’kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC, Beaugrand M. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol. 2006;45:230–5.CrossRefGoogle Scholar
  17. 17.
    Lemoine M, Katsahian S, Ziol M, Nahon P, Ganne-Carrie N, Kazemi F, et al. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment Pharmacol Ther. 2008;28:1102–10.CrossRefGoogle Scholar
  18. 18.
    Bureau C, Metivier S, Peron JM, Selves J, Robic MA, Gourraud PA, et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease. Aliment Pharmacol Ther. 2008;27:1261–8.CrossRefGoogle Scholar
  19. 19.
    Reiberger T, Ferlitsch A, Payer BA, Pinter M, Schwabl P, Stift J, et al. Noninvasive screening for liver fibrosis and portal hypertension by transient elastography–a large single center experience. Wien Klin Wochenschr. 2012;124:395–402.CrossRefGoogle Scholar
  20. 20.
    Llop E, Berzigotti A, Reig M, Erice E, Reverter E, Seijo S, et al. Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol. 2012;56:103–8.CrossRefGoogle Scholar
  21. 21.
    Berzigotti A, Seijo S, Arena U, Abraldes JG, Vizzutti F, García-Pagán JC, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144:102–111.e1.CrossRefGoogle Scholar
  22. 22.
    Hong WK, Kim MY, Baik SK, Shin SY, Kim JM, Kang YS, et al. The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data. Clin Mol Hepatol. 2013;19:370–5.CrossRefGoogle Scholar
  23. 23.
    Salzl P, Reiberger T, Ferlitsch M, Payer BA, Schwengerer B, Trauner M, et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index. Ultraschall Med. 2014;35:528–33.CrossRefGoogle Scholar
  24. 24.
    Zykus R, Jonaitis L, Petrenkienė V, Pranculis A, Kupčinskas L. Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study. BMC Gastroenterol. 2015;15:183.CrossRefGoogle Scholar
  25. 25.
    Procopet B, Cristea VM, Robic MA, Grigorescu M, Agachi PS, Metivier S, et al. Serum tests, liver stiffness and artificial neural networks for diagnosing cirrhosis and portal hypertension. Dig Liver Dis. 2015;47:411–6.CrossRefGoogle Scholar
  26. 26.
    Kitson MT, Roberts SK, Colman JC, Paul E, Button P, Kemp W. Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications. Scand J Gastroenterol. 2015;50:462–9.CrossRefGoogle Scholar
  27. 27.
    Elkrief L, Rautou PE, Ronot M, Lambert S, Dioguardi Burgio M, Francoz C, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275:589–98.CrossRefGoogle Scholar
  28. 28.
    Schwabl P, Bota S, Salzl P, Mandorfer M, Payer BA, Ferlitsch A, et al. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver Int. 2015;35:381–90.CrossRefGoogle Scholar
  29. 29.
    Bolognesi M, Merkel C, Sacerdoti D, Nava V, Gatta A. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 2002;34:144–50.CrossRefGoogle Scholar
  30. 30.
    Talwalkar JA, Yin M, Venkatesh S, Rossman PJ, Grimm RC, Manduca A, et al. Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension. AJR Am J Roentgenol. 2009;193:122–7.CrossRefGoogle Scholar
  31. 31.
    Hirooka M, Ochi H, Koizumi Y, Kisaka Y, Abe M, Ikeda Y, et al. Splenic elasticity measured with real-time tissue elastography is a marker of portal hypertension. Radiology. 2011;261:960–8.CrossRefGoogle Scholar
  32. 32.
    Stefanescu H, Grigorescu M, Lupsor M, Procopet B, Maniu A, Badea R. Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. J Gastroenterol Hepatol. 2011;26:164–70.CrossRefGoogle Scholar
  33. 33.
    Colecchia A, Montrone L, Scaioli E, Bacchi-Reggiani ML, Colli A, Casazza G, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology. 2012;143:646–54.CrossRefGoogle Scholar
  34. 34.
    Takuma Y, Nouso K, Morimoto Y, et al. Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. Gastroenterology. 2013;144:92–101.e2.CrossRefGoogle Scholar
  35. 35.
    Bota S, Sporea I, Sirli R, Focsa M, Popescu A, Danila M, et al. Can ARFI elastography predict the presence of significant esophageal varices in newly diagnosed cirrhotic patients? Ann Hepatol. 2012;11:519–25.PubMedGoogle Scholar
  36. 36.
    Vermehren J, Polta A, Zimmermann O, Herrmann E, Poynard T, Hofmann WP, et al. Comparison of acoustic radiation force impulse imaging with transient elastography for the detection of complications in patients with cirrhosis. Liver Int. 2012;32:852–8.CrossRefGoogle Scholar
  37. 37.
    Ye XP, Ran HT, Cheng J, Zhu YF, Zhang DZ, Zhang P, et al. Liver and spleen stiffness measured by acoustic radiation force impulse elastography for noninvasive assessment of liver fibrosis and esophageal varices in patients with chronic hepatitis B. J Ultrasound Med. 2012;31:1245–53.CrossRefGoogle Scholar
  38. 38.
    Kim HY, Jin EH, Kim W, Lee JY, Woo H, Oh S, et al. The role of spleen stiffness in determining the severity and bleeding risk of esophageal varices in cirrhotic patients. Medicine (Baltimore). 2015;94:e1031.CrossRefGoogle Scholar
  39. 39.
    Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Takabatake H, et al. Portal hypertension in patients with liver cirrhosis: diagnostic accuracy of spleen stiffness. Radiology. 2016;279:609–19.CrossRefGoogle Scholar
  40. 40.
    Furuichi Y, Moriyasu F, Taira J, Sugimoto K, Sano T, Ichimura S, et al. Noninvasive diagnostic method for idiopathic portal hypertension based on measurements of liver and spleen stiffness by ARFI elastography. J Gastroenterol. 2013;48:1061–8.CrossRefGoogle Scholar
  41. 41.
    Sharma P, Mishra SR, Kumar M, Sharma BC, Sarin SK. Liver and spleen stiffness in patients with extrahepatic portal vein obstruction. Radiology. 2012;263:893–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
  2. 2.Department of Gastroenterology and HepatologySanno HospitalTokyoJapan

Personalised recommendations